New Student Interview Form

Please answer the following questions then click the Submit button on the bottom of the page.
If you prefer filling on paper, please open
New Student Interview Sheet.

(Personal information will be kept in strict confidence.)
Year           Month      Date
1. Today's Date:
2.  Parent's name (if student is under 18):
3.  Student's name:
4.  Student's age (if under 18):
5.  Student's address:
6.  Phone number to reach student:
Home Phone:
Other Phone:
7.  E-mail address to reach student:
8.  Billing Address
(if different from 5):
9.  Where would you like to take piano lessons?:  
In teacher's studio
In student's home
Other place
10.  Please list preferred lesson times.  (i.e. Monday, 4~8 p.m., All day on Saturday)
11.  How long have you taken piano lessons?:
12.  Was there any interruption in the history of your piano lessons?:
13.  In which level do you think you belong?:
Haven't learned piano yet
Beginner's level
Intermediate level (Sonatina, Invention or some Sonata level)
Advanced level
Not known
14.  If you are in beginner's level, which method are you using?:
What Level?
What Level?
What Level?
Which method and what level?
15.  If you are intermediate level, which method are you using?:
16.  Do YOU (student, NOT parents) want to learn piano?:
17.  Do you have a piano at home?:
Acoustic vertical piano
Acoustic grand piano
Electric 88 key piano with pedals
Electric keyboard without pedals
don't have any
18.  What is your purpose of taking piano lessons?  Please mark as many as you like.
I want to be a concert pianist.
I want to be a piano teacher.
I want to be a college piano major.
I want to go to Arts Magnet High School.
I want to attend a local piano competition.
As a part of music education
I want to learn how to teach piano to my child.
19.  Would you like to learn popular music?:
20.  Do you play other musical instruments?:  
Which Instruments do you play?
21.  Do you have a mental / physical handicap which may affect piano lessons?:
If you answered "Yes", please describe:
22.  Do you expect something specific from new piano lessons?:
23.  Do you have other things to tell your new piano teacher?  (Questions will be answered
at an interview session.):
24.  There will be a meeting in either teacher's studio or in student's home before starting
lessons.  The meeting will be fee of charge and with no obligation.  Which place would you
like to have the meeting?
In Teacher's Studio
In Student's Home
25.  Please list possible date and time for the free meeting below so that teacher can
choose.  It is recommended to give about 5 possible slots.
Thank you